Strengthening the Pipeline:

What is Missing to Attract Young Investigators to Latent TB Research

Global Consultation Meeting on the Programmatic Management of LTBI

April 28, 2016

Carina Marquez, MD, MPH

Assistant Professor of Medicine

Division of HIV, Infectious DIseses, and Global Medicine

University of California, San Francisco

Pre-doctoral training

Post-doctoral Training

Mentored Scientist

Independent Investigator

Pre-Doctoral Post-

Doctoral Mentored Scientist

Pipeline Towards Independence in Latent TB Research

4 years undergraduate training in biology at Harvard 2 years as a Technical Officer at WHO 4 years of Medical School at UCSF

3 year Internal Medicine Residency at UCSF 3 year Fellowship in Infectious Diseases at UCSF 1 year Masters in Public Health at UC Berkeley

Faculty at UCSF 5-Year Mentored Scientist (K23) Award from the National Institutes of Health

Characterizing the TB Reservoir in Rural Uganda

Marquez unpublished data

3 Rural Communities in Eastern Uganda, N=2076

When and where do children and young adults acquire TB?

Kamuge, Eastern Uganda, population 10,000

CHURCH

HEALTH CENTER

SCHOOL

HOUSEHOLD

Challenges Along the Pipeline to Research Independence

(1) Logistical Challenges Unique to Latent TB - Diagnostics - Long treatment durations - Longitudinal studies

(2) Career Identity - Strengthening access to multidisciplinary mentorship - Virtual Networking

(3) Long-Term Investment in Young Investigators focused

on TB and Latent TB

Logistical Challenges Unique to Latent TB Diagnostics

33.7

23.2 19.3 18.2

2.3 5.3 5.1 3.8

0

5

10

15

20

25

30

35

40

1-11 12-23 24-35 36-60

%

Age (months)

TST

QFT

Marquez PIDJ 2016

TST positivity and QFT Positivity in Children <60 Months, Rural Uganda

Lack of gold standard to measure LTBI

Tuberculin Skin Test Training in Eastern Uganda IGRA testing performed in the Tororo immunology lab in Eastern Uganda

Logistical challenges with TB diagnostics: Availability, cost, follow-up, laboratory infrastructure

• Large community or clinic based cohorts are needed to study TB transmission and

prevention. • Large clinical trial consortiums needed to study clinical outcomes and treatment

durations are long

• Reliable electronic surveillance systems and clinic-based cohorts needed to conduct implementation science research.

Strong Partnership with local and national public health department

Logistical Challenges Unique to Latent TB Large Longitudinal Studies

Bugamba Level IV Health Center, Southwest Uganda

Community Engagement

SEARCH study, Uganda

Logistical Challenges Unique to Latent TB Solutions

• Increase access to TB specific start-up funds to allow young investigators to gather primary data.

• Formalize roles and funding opportunities for post-doctoral investigators/fellows in TB clinical trial consortiums.

-Can we make a ACTG (TBTSG) or TBTC scholars program for post-doctoral scholars?

Trainee

Maya Petersen, MD, PhD UC, Berkeley Biostatistics,

Epidemiology, Social Network Analysis,

Causal Inference

Edwin Charlebois PhD, MPH

UCSF Biostatistics, Epidemiology

The Need for Multidisciplinary Mentorship Teams

Annie Luetkemeyer, MD UCSF

TB Diagnostics, TB Clinical Trials

Jane Achan, MBChB, PhD Makerere University, Uganda

Pediatric Clinical Research

Diane Havlir, MD Primary Mentor HIV/TB Clinical research, Community Based Research

Moses Kamya, MBChB, PhD Makerere University, Uganda Clinical research

Career Identity

Career Identity Solutions

• Increase exposure to high-level TB meetings

– Expanding young investigator attendance at

WHO HIV/TB Research Frontiers Pre-IAS and CROI meetings

• Establish peer and near-peer mentoring groups.

– Young Investigator Symposiums at Scientific Meetings

– Virtual Peer and Near-Peer Networks

Long Term Investment in Young Investigators

“I think one of the main challenges in our settings is really the default position researchers commonly find ourselves in; that of implementers of projects. We are usually occupied with the administrative and field/data collection aspects of the different projects and ultimately miss out on the full appreciation of the science?” -Early Career Investigator, Uganda

Short Term • Skill building workshops • Start-up Funds • Support for Masters Programs • Earmarked awards for young

investigators from IAS, Union

Long Term Investment • Support for PhD programs –LIC

• Internal 5-6 year career development

program

Examples: (1) Medicine Research Council’s Program Leader-Track. -6 year internal career development program for post-doctoral scholars (2) Fogarty HIV-TB Training Programs -BJGMC-JHU Fogarty (3) National Institutes of Health Career Development Awards -K43 for Investigators from a LMIC

Long term investment in Young Investigators Solutions

IDRC and MU-UCSF Young Investigators Workshop, Kampala, Uganda 2016

Thank You

IDRC Young Investigators Workshop, Kampala Uganda

UCSF Diane Havlir

Edwin Charlebois Maya Petersen

Annie Luetkemeyer Gabriel Chamie

Makerere University Moses Kamya Jane Achan

Infectious Diseases Research Collaboration

Emmauel Ssemondo Mary Kyohere

Florence Mwagana

WHO Haileyesus Getahun